Long training duration, poor pay, causing anaesthesiologists’ dearth – Expert

An anaesthesiologist at the Irrua Specialist Teaching Hospital, Edo State, Dr. Julian Ojebo, has attributed the dearth of anaesthesiologists in Nigeria to long training duration and poor remuneration.

He noted that many secondary and tertiary medical facilities in the country either had few of the specialists or none at all.

Ojebo described anaesthesiologists as specialists who administer anaesthetic (a drug that causes temporary loss of bodily sensation) for all surgical interventions and procedures, noting that they were needed in virtually all areas of medicine.

He explained that anaesthesia was a specialty of medicine dealing with reversible, controllable and predictable methods of pain relief for operative surgery, with or without loss of consciousness, and that it could only be studied at the postgraduate level.

“Anaesthesia is a wide field that involves obstetrics anaesthesia, cardiothoracic anaesthesia, neurosurgical anaesthesia and anaesthesia for labour analgesia, which is a component of obstetrics anaesthesia,” he said.

The US National Library of Medicine, National Institute of Health, described anaesthesiologists as those that take care of patients by protecting them from any possible untoward events during anaesthesia and surgery by providing the best possible pain relief.

It noted that the service would enable optimum as well as comfortable working conditions for the surgeons and that it was the anaesthesiologist, who carried out the above-mentioned duties to the path of safety.

Ojebo revealed that graduate doctors were not encouraged to delve into the specialty because of the long duration of training involved, which could be financially draining and time-consuming.

He said, “The training for an average anaesthesiologist all over the world, before you can be board certified or a fellow in any country, takes a minimum of five to seven years. And the training is usually at the postgraduate level.

“For Nigeria, it is currently divided into two subsets, the junior residency and senior residency. The junior residency takes three years, while the senior residency is for three years. The minimum duration is six years.

“It’s quite stressful going through this training. A lot of people don’t want to go through the stress, because it provides services for all the medical departments.”

The anaesthesiologist said financing the long-term programme remained a challenge facing the specialty, particularly in low and medium-income countries like Nigeria.

“It is a problem compared to developed countries where anaesthesiology is one of the top-paying jobs,” he added.

The medical practitioner decried lack of awareness given the specialty at undergraduate level, noting that the time allotted was never sufficient.

He said, “When I was in medical school, I did anaesthesia rotation for just two weeks. Exposure of anaesthesia to people at that cadre is usually not much.

“The crux is that the duration of the training is long and tedious. Long working hours, long calls and exposure to anaesthetic gases, all culminate in causing a dearth in the number of anaesthesiologists in the world.”

Based on reports, other factors fuelling the shortage of manpower in anaesthesia include medical tourism, lack of training institutions, ill-equipped medical schools, lack of theatres and anaesthetic equipment for surgical procedures.

As of 2019, experts revealed that there were about 3,000 anaesthetists rendering healthcare services in Nigeria, which is relatively inadequate to the entire population of over 200 million people.

It was also noted that at the time, Nigeria had only 221 consultant anaesthetists and about 660 trainee anaesthetists at various stages of training.

Nigeria has an estimated ratio of one anaesthetist to about 200,000 to 300,000 persons as against the World Health Organisation’s ratio of one anaesthetist to 10,000 patients.

However, research showed that the dearth of anaesthesiologists was not peculiar to Nigeria.

The Association of American Medical Colleges projected that there would be a shortage of doctors, up to 124,000, by 2034, and one of the critical groups to be affected was anaesthesia.

Similarly, the Royal College of Anaesthetists, in September 2019, announced a shortage of 1, 400 National Health Service anaesthetists, adding that one-in-four anaesthetists had a plan to leave the employ of the United Kingdom in the next five years.

This, according to the college, may amount to a delay of more than one million surgical procedures yearly.

Speaking on this, Ojebo advised that the specialty be given enough attention at the undergraduate level and incentives should be given to those interested in the field.

He stated, “More awareness needs to be created and the public should also be educated on the importance of the field. Only a few know about anaesthesia.

“The National Postgraduate Medical College of Nigeria and the West African College of Surgeons are the ones that have facilities to train postgraduate students at that level.

“They give you accreditation. In almost all the teaching hospitals, they have accredited centres for anaesthesia and critical care medicine.”

He recommended that incentives be given to medical students interested in majoring in the field, noting that it should be in the form of foreign exposure and collaboration with foreign training institutions.

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